Identifying research priorities for improving information and support for patients undergoing breast cancer surgery: a UK patient-centred priority setting project.

PURPOSE: To use robust consensus methods with individuals with lived breast cancer experience to agree the top 10 research priorities to improve information and support for patients undergoing breast cancer surgery in the UK. METHODS: Research uncertainties related to information and support for breast cancer surgery submitted by patients and carers were analysed thematically to generate summary questions for inclusion in an online Delphi survey. Individuals with lived breast cancer experience completed two Delphi rounds including feedback in which they selected their top 10 research priorities from the list provided. The most highly ranked priorities from the survey were discussed at an in-person prioritisation workshop at which the final top 10 was agreed. RESULTS: The 543 uncertainties submitted by 156 patients/carers were categorised into 63 summary questions for inclusion in the Delphi survey. Of the 237 individuals completing Round 1, 190 (80.2%) participated in Round 2. The top 25 survey questions were carried forward for discussion at the in-person prioritisation workshop at which 17 participants from across the UK agreed the final top 10 research priorities. Key themes included ensuring patients were fully informed about all treatment options and given balanced, tailored information to support informed decision-making and empower their recovery. Equity of access to treatments including contralateral mastectomy for symmetry was also considered a research priority. CONCLUSION: This process has identified the top 10 research priorities to improve information and support for patients undergoing breast cancer surgery. Work is now needed to develop studies to address these important questions.

Spatial variation in microbial communities associated with sea-ice algae in Commonwealth Bay, East Antarctica.

Antarctic sea-ice forms a complex and dynamic system that drives many ecological processes in the Southern Ocean. Sea-ice microalgae and their associated microbial communities are understood to influence nutrient flow and allocation in marine polar environments. Sea-ice microalgae and their microbiota can have high seasonal and regional (>1000 km2) compositional and abundance variation, driven by factors modulating their growth, symbiotic interactions and function. In contrast, our knowledge of small-scale variation in these communities is limited. Understanding variation across multiple scales and its potential drivers is critical for informing on how multiple stressors impact sea-ice communities and the functions they provide. Here, we characterized bacterial communities associated with sea-ice microalgae and the potential drivers that influence their variation across a range of spatial scales (metres to >10 kms) in a previously understudied area in Commonwealth Bay, East Antarctica where anomalous events have substantially and rapidly expanded local sea-ice coverage. We found a higher abundance and different composition of bacterial communities living in sea-ice microalgae closer to the shore compared to those further from the coast. Variation in community structure increased linearly with distance between samples. Ice thickness and depth to the seabed were found to be poor predictors of these communities. Further research on the small-scale environmental drivers influencing these communities is needed to fully understand how large-scale regional events can affect local function and ecosystem processes.

Plastic Debris As a Vector for Bacterial Disease: An Interdisciplinary Systematic Review.

Pathogens and polymers can separately cause disease; however, environmental and medical researchers are increasingly investigating the capacity of polymers to transfer pathogenic bacteria, and cause disease, to hosts in new environments. We integrated causal frameworks from ecology and epidemiology into one interdisciplinary framework with four stages (colonization, survival, transfer, disease). We then systematically and critically reviewed 111 environmental and medical papers. We show 58% of studies investigated the colonization-stage alone but used this as evidence to classify a substratum as a vector. Only 11% of studies identified potential pathogens, with only 3% of studies confirming the presence of virulence-genes. Further, 8% of studies investigated µm-sized polymers with most (58%) examining less pervasive cm-sized polymers. No study showed bacteria can preferentially colonize, survive, transfer, and cause more disease on polymers compared to other environmental media. One laboratory experiment demonstrated plausibility for polymers to be colonized by a potential pathogen (Escherichia coli), survive, transfer, and cause disease in coral (Astrangia poculata). Our analysis shows a need for linked structured surveys with environmentally relevant experiments to understand patterns and processes across the vectoral stages, so that the risks and impacts of pathogens on polymers can be assessed with more certainty.

Desalination Discharge Influences the Composition of Reef Invertebrate and Fish Assemblages.

Large-scale desalination is used increasingly to address growing freshwater demands and climate uncertainty. Discharge of hypersaline brine from desalination operations has the potential to impact marine ecosystems. Here, we used a 7-year Multiple-Before-After-Control-Impact experiment to test the hypothesis that hypersaline discharge from reverse osmosis desalination alters temperate reef communities. Using replicated, video-based, timed searches at eight sites, we sampled fish and invertebrate assemblages before, during, and after the discharge of hypersaline brine. We found that the composition of fish assemblages was significantly altered out to 55 m while the composition of invertebrate assemblages was altered out to 125 m from the outlet during hypersaline discharge. Fish richness and functional diversity increased around the outlet, while the invertebrate assemblages were no less diverse than those on reference reefs. Differences in faunal assemblages between outlet and reference sites during discharging included changes in the frequency of occurrence of both common and rare reef biota. Overall, we found the influence of hypersaline discharge on temperate reef biota to be spatially localized, with the reefs around the outlet continuing to support rich and diverse faunal communities. In some cases, therefore, the marine environmental consequences of large-scale, well-designed, desalination operations may be appropriately balanced against the positive benefits of improved water security.

Evaluating the social and ecological effectiveness of partially protected marine areas.

Marine protected areas (MPAs) are a primary tool for the stewardship, conservation, and restoration of marine ecosystems, yet 69% of global MPAs are only partially protected (i.e., are open to some form of fishing). Although fully protected areas have well-documented outcomes, including increased fish diversity and biomass, the effectiveness of partially protected areas is contested. Partially protected areas may provide benefits in some contexts and may be warranted for social reasons, yet social outcomes often depend on MPAs achieving their ecological goals to distinguish them from open areas and justify the cost of protection. We assessed the social perceptions and ecological effectiveness of 18 partially protected areas and 19 fully protected areas compared with 19 open areas along 7000 km of coast of southern Australia. We used mixed methods, gathering data via semistructured interviews, site surveys, and Reef Life (underwater visual census) surveys. We analyzed qualitative data in accordance with grounded theory and quantitative data with multivariate and univariate linear mixed-effects models. We found no social or ecological benefits for partially protected areas relative to open areas in our study. Partially protected areas had no more fish, invertebrates, or algae than open areas; were poorly understood by coastal users; were not more attractive than open areas; and were not perceived to have better marine life than open areas. These findings provide an important counterpoint to some large-scale meta-analyses that conclude partially protected areas can be ecologically effective but that draw this conclusion based on narrower measures. We argue that partially protected areas act as red herrings in marine conservation because they create an illusion of protection and consume scarce conservation resources yet provide little or no social or ecological gain over open areas. Fully protected areas, by contrast, have more fish species and biomass and are well understood, supported, and valued by the public. They are perceived to have better marine life and be improving over time in keeping with actual ecological results. Conservation outcomes can be improved by upgrading partially protected areas to higher levels of protection including conversion to fully protected areas.

Análisis de la Efectividad Social y Ecológica de las Áreas Marinas Parcialmente Protegidas Resumen Las áreas marinas protegidas (AMPs) son una herramienta importante para la administración, conservación y restauración de los ecosistemas marinos; sin embargo, el 69% de las AMPs mundiales solamente están parcialmente protegidas (es decir, están abiertas a alguna forma de pesca). Aunque las áreas completamente protegidas tienen resultados bien documentados, incluyendo el incremento en la diversidad de peces y la biomasa, la efectividad de las áreas parcialmente protegidas está en disputa. Puede que las áreas parcialmente protegidas se justifiquen por razones sociales, aunque los resultados sociales con frecuencia dependen de que las AMPs alcancen sus metas ecológicas para distinguirlas de las áreas abiertas y justificar el costo de la protección. Analizamos las percepciones sociales y la efectividad ecológica de 18 áreas parcialmente protegidas y 19 áreas completamente protegidas a lo largo de 7000 km de costa en el sur de Australia. Usamos métodos mixtos, recopilando información por medio de entrevistas semiestructuradas, encuestas en sitio y censos Reef Life (censos visuales submarinos). Analizamos los datos cualitativos de acuerdo con la teoría fundamentada y los datos cuantitativos con modelos lineales de efectos mixtos multivariados y univariados. No encontramos beneficios sociales o ecológicos para las áreas parcialmente protegidas en relación con las áreas abiertas en nuestro estudio. Las áreas parcialmente protegidas no tuvieron más peces, invertebrados o algas que las áreas abiertas; los usuarios de la costa tenían poco entendimiento de ellas; no eran más atractivas que las áreas abiertas; y no eran percibidas como albergues de mejor vida marina que las áreas abiertas. Estos hallazgos proporcionan un contrapunto importante a algunos metaanálisis a gran escala que concluyen que las áreas parcialmente protegidas pueden ser ecológicamente efectivas, pero llegan a esta conclusión con base en medidas más reducidas. Discutimos que las áreas parcialmente protegidas funcionan como pistas falsas para la conservación marina pues crean una ilusión de estar protegidas y consumen pocos recursos para la conservación, pero proporcionan poca o ninguna ganancia ecológica o social en comparación con las áreas abiertas. Las áreas completamente protegidas, al contrario, tienen más especies de peces y biomasa y están bien comprendidas, respaldadas y valoradas por el público. Este tipo de AMPs son percibidas como albergues de mejor vida marina y como en constante mejora con el tiempo al mantenerse en regla con los resultados ecológicos actuales. Los resultados de la conservación pueden mejorarse si se eleva a las áreas parcialmente protegidas a niveles más altos de protección incluyendo la conversión a áreas completamente protegidas.

Pharyngoplasty for Speech Disorders Following Brain Injury.

INTRODUCTION: Dysarthria is one of the commonest neurological speech disorders resulting from brain injury. However, hypernasality commonly co-exists in this subgroup of patients and is commonly overlooked. The authors aim to investigate the merit of surgery in improving hypernasality and speech intelligibility in patients with a mixed pattern of dysarthria and hypernasality secondary to brain injury. MATERIALS AND METHODS: Data was collected from the regional plastic surgery unit over a 10-year period. All patients who underwent a pharyngoplasty for speech improvement following total brain injury from either a traumatic injury or a cerebrovascular accident were included. Patients were followed up post-operatively to assess; improvement in speech rehabilitation, complications and the need for surgical revision. RESULTS: Six patients had a pharyngoplasty for speech improvement. Either a Hynes or Jackson pharyngoplasty was performed, with one patient requiring a hemi-pharyngoplasty. Post-operatively, 1 patient experienced self-limiting sleep apnea which resolved within 1 month. One patient developed obstructive symptoms and required revision. Overall, 83% of patients had clear improvement in speech intelligibility and articulation. CONCLUSIONS: The authors have shown that surgical intervention, in the form of a pharyngoplasty, is an effective method of improving speech intelligibility and articulation, by improving hypernasality and restoring communication in this cohort of patients. The aim of this paper is to highlight this option to colleagues and to heighten the awareness that many patients with a total brain injury have a mixed pattern of speech disturbance and not solely the dysarthria that is attributed to this condition.

Modeling recreational fishing intensity in a complex urbanised estuary.

Urbanised estuaries, ports and harbours are often utilised for recreational purposes, notably recreational angling. Yet there has been little quantitative assessment of the footprint and intensity of these activities at scales suitable for spatial management. Urban and industrialised estuaries have previously been considered as having low conservation value, perhaps due to issues with contamination and disturbance. Studies in recent decades have demonstrated that many of these systems are still highly biodiverse and of high value to local residents. As a response, urbanised estuaries are now being considered by coastal spatial management initiatives, where assessments of recreational use in these areas can help avoid 'user-environmental' and 'user-user' conflict. The models of these activities need to be developed at a scale relevant to governments and regulatory authorities, but the few human-use models that do exist integrate fishing intensity to a regional or even continental scale; too large to capture the fine scale variation inherent in complex urban fisheries. Species Distribution Modeling (SDM) is a tool commonly used to assess drivers of species range, but can be applied to models of recreational fishing in complex environments, at a scale relevant to regulatory bodies. Using point-data from 573 visual surveys with recently developed Poisson point process models, we examine the recreational fishery in Australia's busiest estuarine port, Sydney Harbour. We demonstrate the utility of these models for understanding the distribution of boat and shore-based fishers, and the effects of a range of temporally static (geographical) and dynamic (weather) predictors on these distributions.

Effect of Desalination Discharge on the Abundance and Diversity of Reef Fishes.

Global growth in desalination industries has increased the need for an evidence-based understanding of associated environmental impacts. We completed a seven-year assessment of the responses of fish assemblages to hypersaline discharge from the large Sydney Desalination Plant. At 12 times before, eight times during, and four times following the cessation of discharging hypersaline brine, we sampled reef fishes at two outlet sites and two close reference sites, as well as four reference sites that were located from 2-8 km from the outlet. At each site and each time of sampling, five 50 m video transects were used to sample reef fish assemblages. Following the commencement of discharging, there was a 279% increase in the abundance of fish around the outlet, which included substantially greater abundances of pelagic and demersal fish, as well as fishes targeted by recreational and commercial fishers. Following the cessation of discharge, abundances of fishes mostly returned to levels such that there was no longer a significant effect compared to the period prior to the commencement of the desalination plant's operations. Overall, our results demonstrate that well-designed marine infrastructure and processes used to support the growing demand for potable water can also enhance local fish abundances and species richness.

Predicting the impact of sea-level rise on intertidal rocky shores with remote sensing.

Sea-level rise is an inevitable consequence of climate change and threatens coastal ecosystems, particularly intertidal habitats that are constrained by landward development. Intertidal habitats support significant biodiversity, but also provide natural buffers from climate-threats such as increased storm events. Predicting the effects of climate scenarios on coastal ecosystems is important for understanding both the degree of habitat loss for associated ecological communities and the risk of the loss of coastal buffer zones. We take a novel approach by combining remote sensing with the IUCN Red List of Ecosystem criteria to assess this impact. We quantified the extent of horizontal intertidal rocky shores along ~200 km of coastline in Eastern Australia using GIS and remote-sensing (LiDAR) and used this information to predict changes in extent under four different climate change driven sea-level rise scenarios. We then applied the IUCN Red List of Ecosystems Criterion C2 (habitat degradation over the next 50 years based on change in an abiotic variable) to estimate the status of this ecosystem using the Hawkesbury Shelf Marine Bioregion as a test coastline. We also used four individual rocky shores as case studies to investigate the role of local topography in determining the severity of sea-level rise impacts. We found that, if the habitat loss within the study area is representative of the entire bioregion, the IUCN status of this ecosystem is 'near threatened', assuming that an assessment of the other criteria would return lower categories of risk. There was, however, high spatial variability in this effect. Rocky shores with gentle slopes had the highest projected losses of area whereas rocky shores expanding above the current intertidal range were less affected. Among the sites surveyed in detail, the ecosystem status ranged from 'least concern' to 'vulnerable', but reached 'endangered' under upper estimates of the most severe scenario. Our results have important implications for conservation management, highlighting a new link between remote sensing and the IUCN Red List of Ecosystem criteria that can be applied worldwide to assess ecosystem risk to sea-level rise.

Contrasting distributions of bacteriophages and eukaryotic viruses from contaminated coastal sediments.

Viruses are ubiquitous, abundant and play an important role in all ecosystems. Here, we advance understanding of coastal sediment viruses by exploring links in the composition and abundance of sediment viromes to environmental stressors and sediment bacterial communities. We collected sediment from contaminated and reference sites in Sydney Harbour and used metagenomics to analyse viral community composition. The proportion of phages at contaminated sites was significantly greater than phages at reference sites, whereas eukaryotic viruses were relatively more abundant at reference sites. We observed shifts in viral and bacterial composition between contaminated and reference sites of a similar magnitude. Models based on sediment characteristics revealed that total organic carbon in the sediments explained most of the environmental stress-related variation in the viral dataset. Our results suggest that the presence of anthropogenic contaminants in coastal sediments could be influencing viral community composition with potential consequences for associated hosts and the environment.

Using meta-omics of contaminated sediments to monitor changes in pathways relevant to climate regulation.

Microbially mediated biogeochemical processes are crucial for climate regulation and may be disrupted by anthropogenic contaminants. To better manage contaminants, we need tools that make real-time causal links between stressors and altered microbial functions, and the potential consequences for ecosystem services such as climate regulation. In a manipulative field experiment, we used metatranscriptomics to investigate the impact of excess organic enrichment and metal contamination on the gene expression of nitrogen and sulfur metabolisms in coastal sediments. Our gene expression data suggest that excess organic enrichment results in (i) higher transcript levels of genes involved in the production of toxic ammonia and hydrogen sulfide and (ii) lower transcript levels associated with the degradation of a greenhouse gas (nitrous oxide). However, metal contamination did not have any significant impact on gene expression. We reveal the genetic mechanisms that may lead to altered productivity and greenhouse gas production in coastal sediments due to anthropogenic contaminants. Our data highlight the applicability of metatranscriptomics as a management tool that provides an immense breadth of information and can identify potentially impacted process measurements that need further investigation.

Habitat complexity effects on diversity and abundance differ with latitude: an experimental study over 20 degrees.

Habitat complexity is accepted as a general mechanism for increasing the abundance and diversity of communities. However, the circumstances under which complexity has the strongest effects are not clear. Over 20 degrees of Australia's east coast, we tested whether the effects of within-site structural habitat complexity on the diversity and community structure of sessile marine invertebrates was consistent over a latitudinal gradient where environmental conditions and species composition vary. We used experimental arrays with varied structural treatments to detect whether community cover, species richness, diversity and community composition (ß-diversity) changed with increasing complexity. Community response to complexity varied over latitude due to differences in species richness and community development. Increased complexity had the greatest positive effects on community cover and species richness at higher latitudes where recruitment and growth were low. At lower latitudes, community cover and species richness were higher overall and did not vary substantially between complexity treatments. Latitudinal variation in within-treatment ß-diversity relative to complexity further suggest divergent community responses. At higher latitudes, increased similarity in more complex treatments suggests community dominance of successful taxonomic groups. Despite limited effects on species richness and community cover at lower latitudes, ß-diversity was higher in more complex treatments, signifying potential positive effects of increased complexity at these sites. These results demonstrate the context-dependency of complexity effects in response to variation in species richness and community development and should be taken into consideration to help direct conservation and restoration efforts.

Exploring the social dimension of sandy beaches through predictive modelling.

Sandy beaches are unique ecosystems increasingly exposed to human-induced pressures. Consistent with emerging frameworks promoting this holistic approach towards beach management, is the need to improve the integration of social data into management practices. This paper aims to increase understanding of links between demographics and community values and preferred beach activities, as key components of the social dimension of the beach environment. A mixed method approach was adopted to elucidate users' opinions on beach preferences and community values through a survey carried out in Manly Local Government Area in Sydney Harbour, Australia. A proposed conceptual model was used to frame demographic models (using age, education, employment, household income and residence status) as predictors of these two community responses. All possible regression-model combinations were compared using Akaike's information criterion. Best models were then used to calculate quantitative likelihoods of the responses, presented as heat maps. Findings concur with international research indicating the relevance of social and restful activities as important social links between the community and the beach environment. Participant's age was a significant variable in the four predictive models. The use of predictive models informed by demographics could potentially increase our understanding of interactions between the social and ecological systems of the beach environment, as a prelude to integrated beach management approaches. The research represents a practical demonstration of how demographic predictive models could support proactive approaches to beach management.

Latitudinal variation in the competition-colonisation trade-off reveals rate-mediated mechanisms of coexistence.

Theories of species coexistence often describe a trade-off between colonising and competitive abilities. In sessile marine invertebrates, this trade-off can manifest as trends in species distributions relative to the size of isolated patches of substrate. Based on their abilities to find available substrate and competitively exclude neighbours, good colonisers tend to dominate smaller patches, whereas better competitors tend to monopolise larger patches. In theory, species with equivalent colonising and competitive abilities should display similar distributions across patch sizes. We used patch size to observe this manifestation of the competition-colonisation trade-off over 20° of latitude. The trade-off was more readily observed at lower latitudes and was proportional to the 'ecological age' of communities (i.e. the degree of resource acquisition and likelihood of species interactions). Results suggest that ecological age may mediate the prominence of stochastic or deterministic coexistence mechanisms and will depend on the rate of ecological processes.

An empirical examination of consumer effects across twenty degrees of latitude.

The strength and importance of consumer effects are predicted to increase toward low latitudes, but this hypothesis has rarely been tested using a spatially consistent methodology. In a consumer-exclusion experiment spanning twenty degrees of latitude along the east Australian coast, the magnitude of consumer effects on sub-tidal sessile assemblage composition was not greater at low than high latitudes. Across caged and control assemblages, Shannon's diversity, Pielou's evenness, and richness of functional groups decreased with increasing latitude, but the magnitude of consumer effects on these metrics did not display consistent latitudinal gradients. Instead, latitudinal gradients in consumer effects were apparent for individual functional groups. Solitary ascidians displayed the pattern consistent with predictions of greater direct effects of predators at low than high latitude. As consumers reduced the biomass of this and other competitive dominants, groups less prone to predation (e.g., hydroids, various groups of bryozoans) were able to take advantage of freed space in the presence of consumers and show increased abundances there. This large-scale empirical study demonstrates the complexity of species interactions, and the failure of assemblage-level metrics to adequately capture consumer effects over large spatial gradients.

The Abdominal Reapproximation Anchor Device.

INTRODUCTION: Achieving primary fascial closure after damage control laparostomy can be challenging. A number of devices are in use, with none having yet emerged as best practice. In July 2013, at Westmead Hospital, we started using the abdominal reapproximation anchor (ABRA; Canica Design, Almonte, Ontario, Canada) device. We report on our experience. METHODS: A retrospective review of medical records for patients who had open abdomens managed with the ABRA device between July to December 2013 was done. Data extracted included age, sex, body mass index (BMI), reason for the open abdomen, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, number of laparostomies prior to ABRA placement, duration of placement, device complications, length of hospital and intensive care unit (ICU) stay, and outcomes. RESULTS: Four cases of open abdomens managed using the ABRA device were identified, with 3 a consequence of intra-abdominal sepsis and 1 a consequence of penetrating trauma. Mean BMI was 33.5 kg/m2, APACHE II score was 14.5, duration with open abdomen prior to ABRA placement was 11.75 days, duration with ABRA in situ was 9 days, duration of hospital stay was 64.25 days, and ICU stay was 37.75 days. Three patients (75%) achieved fascial closure, and 1 achieved skin closure. No incidences of enterocutaneous fistulae occurred. CONCLUSION: The ABRA is a unique emerging alternative to aid in achieving fascial closure in patients managed with open abdomens. Our case series demonstrates that it can be used effectively in selected patients. Studies are needed to compare its efficacy with more traditional methods.

Improving psychosocial outcomes for caregivers of people with poor prognosis gastrointestinal cancers: a randomized controlled trial (Family Connect).

PURPOSE: This study investigated the effectiveness of a structured telephone intervention for caregivers of people diagnosed with poor prognosis gastrointestinal cancer to improve psychosocial outcomes for both caregivers and patients. METHODS: Caregivers of patients starting treatment for upper gastrointestinal or Dukes D colorectal cancer were randomly assigned (1:1) to the Family Connect telephone intervention or usual care. Caregivers in the intervention group received four standardized telephone calls in the 10 weeks following patient hospital discharge. Caregivers' quality of life (QOL), caregiver burden, unmet supportive care needs and distress were assessed at 3 and 6 months. Patients' QOL, unmet supportive care needs, distress and health service utilization were also assessed at these time points. RESULTS: Caregivers (128) were randomized to intervention or usual care groups. At 3 months, caregiver QOL scores and other caregiver-reported outcomes were similar in both groups. Intervention group participants experienced a greater sense of social support (p = .049) and reduced worry about finances (p = .014). Patients whose caregiver was randomized to the intervention also had fewer emergency department presentations and unplanned hospital readmissions at 3 months post-discharge (total 17 vs. 5, p = .01). CONCLUSIONS: This standardized intervention did not demonstrate any significant improvements in caregiver well-being but did result in a decrease in patient emergency department presentations and unplanned hospital readmissions in the immediate post-discharge period. The trend towards improvements in a number of caregiver outcomes and the improvement in health service utilization support further development of telephone-based caregiver-focused supportive care interventions.

The effects of substratum material and surface orientation on the developing epibenthic community on a designed artificial reef.

Artificial reefs provide shelter and can be an important source of food for fish depending on the epibenthic community on the structure. The growth and diversity of this community is influenced by the substratum material and the surface orientation of the reef. Settlement plates of four materials (Perspex, sandstone, wood and steel) were deployed in three orientations (upwards, downwards and vertical) at a depth of 33 m on a designed artificial reef (DAR) off the coast of Sydney, Australia. After three months, the steel surfaces had lower invertebrate species richness, total abundance and diversity compared to other surfaces. Steel was not an ideal material for the initial recruitment and growth of epibenthic invertebrates. A longer duration would be required to develop a mature epibenthic community. Surface orientation had species-specific impacts. Surface material and orientation are important factors for developing epibenthic assemblages, and are thus likely to affect the broader artificial reef assemblage, including fish.

Elevated nutrients change bacterial community composition and connectivity: high throughput sequencing of young marine biofilms.

Biofilms are integral to many marine processes but their formation and function may be affected by anthropogenic inputs that alter environmental conditions, including fertilisers that increase nutrients. Density composition and connectivity of biofilms developed in situ (under ambient and elevated nutrients) were compared using 454-pyrosequencing of the 16S gene. Elevated nutrients shifted community composition from bacteria involved in higher processes (eg Pseudoalteromonas spp. invertebrate recruitment) towards more nutrient-tolerant bacterial species (eg Terendinibacter sp.). This may enable the persistence of biofilm communities by increasing resistance to nutrient inputs. A core biofilm microbiome was identified (predominantly Alteromonadales and Oceanospirillales) and revealed shifts in abundances of core microbes that could indicate enrichment by fertilisers. Fertiliser decreased density and connectivity within biofilms indicating that associations were disrupted perhaps via changes to energetic allocations within the core microbiome. Density composition and connectivity changes suggest nutrients can affect the stability and function of these important marine communities.

Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis.

BACKGROUND: The strategy for preoperative management of biliary obstruction in hilar cholangiocarcinoma (HCCA) patients with regards to drainage by endoscopic (EBD) or percutaneous (PTBD) methods is not clearly defined. The aim of this study was to investigate the utility, complications and therapeutic efficacy of these methods in HCCA patients, with a secondary aim to assess the use of portal vein embolization (PVE) in patients undergoing drainage. METHODS: Studies incorporating HCCA patients undergoing biliary drainage prior to curative resection were included (EMBASE and Medline databases). Analyses included baseline drainage data, procedure-related complications and efficacy, post-operative parameters, and meta-analyses where applicable. RESULTS: Fifteen studies were included, with EBD performed in 536 patients (52%). Unilateral drainage of the future liver remnant was undertaken in 94% of patients. There was a trend towards higher procedure conversion (RR 7.36, p = 0.07) and cholangitis (RR 3.36, p = 0.15) rates in the EBD group. Where specified, 134 (30%) drained patients had PVE, in association with a major hepatectomy in 131 patients (98%). Post-operative hepatic failure occurred in 22 (11%) of EBD patients compared to 56 (13%) of PTBD patients, whilst median 1-year survival in these groups was 91% and 73%, respectively. DISCUSSION: The accepted practice is for most jaundiced HCCA patients to have preoperative drainage of the future liver remnant. EBD may be associated with more immediate procedure-related complications, although it is certainly not inferior compared to PTBD in the long term.